Drug: Should we fear an opioid crisis in France?

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Reassure while supporting "vigilance". This is the difficult balancing act of the National Agency for Drug Safety (ANSM) on opioid painkillers. In his latest report, published Wednesday, the health authority actually observed an increase in consumption of these drugs for ten years in the Hexagon. However, and this is no surprise, this increase has been accompanied in recent years by a "worrying" increase in abuses, hospitalizations, poisonings and deaths related to the intake of these analgesics. What is the fear of an opioid epidemic the size of the one that devastated North America for fifteen years? Not really, listening to the explanations of the specialists.

What drugs are we talking about?

Let's start with the definitions. Opiate analgesics are natural, semisynthetic or synthetic substances derived from opium that activate morphine receptors in the brain. "Their indications concern moderate or severe acute pain, for example post-traumatic pain and some chronic pains.Explain a release the director of the French Observatory of Analgesic Drugs (OFMA), Nicolas Authier, who is also head of the department of medical pharmacology at the University Hospital of Clermont-Ferrand.

Particularly powerful and effective, however, have negative effects such as constipation and serious risks of addiction and overdose, regardless of whether they are also "weak" opioid analgesics (tramadol, codeine, opium powder) or "strong" (oxycodone, morphine, fentanyl) ). "Some patients develop a physical dependency, increase the dosage and can switch to a psychological dependence with consequent loss of control of their consumptioncontinues Nicolas Authier. But there is also the risk of respiratory arrest overdose for patients who do not master the drugs, who will want to seek a superior effect against pain or self-medication.

What is the extent of consumption and its consequences?

It should first be noted that the hexagonal consumption of opioid analgesics has been promoted since the 1990s in departmental plans to combat pain. "In those years, in France, we realized that pain was not enough cure"says Nathalie Richard, deputy director of drugs in neurology, analgesics and narcotics at ANSM. As a result, prescriptions for opioid analgesics have increased since then to reach 10 million people in 2015, including women, according to health insurance data. So much so that they accounted for 22% of all painkillers consumed in 2017, primarily to manage cancer pain, but also to regulate chronic pain, such as osteoarticular, suffering from 10 to 12 million French. As for the molecules, tramadol, more and more prescribed, has also benefited from the withdrawal from the market of Di-Antalvic in 2011, before the codeine and opium powder. But the so-called "strong" opioids, such as oxycodone, have also seen their prescription increase by 150% in ten years.

According to ANSM, the increase in consumption of these addictive drugs has been accompanied by an increase in abuse, hospitalization, intoxication and death related to their use. "Without warning, these indicators do not go in the right direction", admits Nathalie Richard, of ANSM, whose report indicates that in fifteen years the admissions have increased by 167%, to reach 40 hospitalizations per million inhabitants in 2017. The number of deaths from overdoses due to these analgesics jumped, without precise data. "There are a few hundred deaths in the year, at least 200, maybe between 500 and a thousand, deplores the director of the OFMA. But it's probably already too much. "

Should we fear a health crisis like North America?

Not enough to pull the alarm bell on the other hand. Despite these developments "Worrying" the health authorities believe that France is (for now?) immune to an opioid epidemic like in the United States and Canada, where it is recalled that 300,000 people have died since the early 2000s as a result of overdose of opiates. "The drug regulatory system protects us more than in the United States: in France, medical advertising is prohibited and the way in which laboratories communicate with doctors is controlled"recalls the pharmacist Nicolas Authier.

And to complete: "On the other hand, we have not noticed, as in the United States, a shift of patients from the use of illicit opioids as a substitute, even if this is one of the potential risks". However, France can do better to better prevent the risks of addiction and overdose. "We encourage health professionals and patients to be vigilant, begs Nathalie Richard. Health authorities must better inform them of the risks of dependence and tolerance ". The specialists call them to review the prescription and delivery conditions of these opioid painkillers to avoid new tragedies.

Florian Bardou

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